Analysis of the initial dose and reduction rate of corticosteroid for ulcerative colitis in clinical practice.
Masataka Masuda, Norimasa Fukata, Yasuki Sano, Shuhei Nishimon, Mamiko Aoi, Takashi Tomiyama, Toshiro Fukui, Mika Omiya, Kazuichi Okazaki, Makoto Naganuma
Published in Aug 2022, Journal of Gastroenterology and Hepatology.
Background and Aim Trends in steroid use and the effects of the initial dose, duration of use, and tapering schedule on clinical efficacy were assessed in Japanese patients with ulcerative colitis (UC) undergoing steroid treatment.
Methods We enrolled 191 cases with UC who underwent steroid treatment between 2006 and 2020. We assessed the difference in clinical remission rates in cases with different initial doses of steroid. Clinical factors for clinical remission at week 4 and discontinuation of corticosteroid within 12 weeks were also assessed.
Results Clinical remission and response at week 4 were obtained in 107 (56.0%) and 58 cases (30.4%), respectively. In hospitalized patients, male sex (odds ratio [OR], 0.373; 95% confidence interval [CI], 0.146–0.956) and younger age (OR, 0.974; 95% CI, 0.951–0.998) were associated with clinical remission at week 4. Partial Mayo score (OR, 0.643; 95% CI, 0.451–0.918) and initial steroid dose of ≥30 mg (OR, 3.278; 95% CI, 1.274–8.435) were associated with clinical remission at week 4 in outpatients. Clinical remission at week 4 (OR, 0.300; (95% CI, 0.126–0.718)) and the steroid dose reduction rate at week 4 (OR, 0.092; 95% CI, 0.036–0.234) were associated with treatment discontinuation within 12 weeks. The proportion of patients in whom corticosteroids were discontinued at week 12 was significantly higher (P = 0.006) in 2016–2020 (28/52; 53.8%) than in 2006–2010 (15/54; 27.8%).
Conclusion The steroid reduction rate at week 4 may be critical for discontinuation within 12 weeks. Withdrawal of corticosteroids has been becoming more appropriate in the last 5 years than before.